Amyloid Goiter Associated with Amyloidosis Secondary to Rheumatoid Arthritis

Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented

Steinert's syndrome presenting as anal incontinence: a case report

<p>Abstract</p> <p>Introduction</p> <p>Myotonic dystrophy (MD) or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.</p> <p>Case Presentation</p> <p>We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45.</p> <p>Conclusions</p> <p>In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis.</p

AN ENDOCRINOLOGICAL APPROACH IN INDIVIDUALS WITH GENDER DYSPHORIA

Gender identity is defined as the acceptation and perception of an individual's body and identity within a certain gender. Individuals with gender dysphoria, as diagnosed by psychiatrists, should also be evaluated in terms of endocrinologic measures, and certain underlying conditions/diseases regarding gender dysphoria must be excluded. Prior to initiation of hormonal and irreversible therapies, it is important for an individual to live suitably with the preferred gender identity as to acquire real life experience. The individual's ability to live in the desired gender is tested in this manner, and whether there is sufficient social, economic, psychological support. Treatment can be initiated for a transgender individual after three months of real-life experience. Before initiation, the reversible and permanent effects must be informed, and the treatment should be individualized. Fertility preservation should be explained prior to hormone therapy, and in those who want to, ovarian preservation in women and sperm preservation in men should be suggested and informed consent obtained. Feminization signs, serum testosterone and estradiol levels, drug side effects, routine cancer screening for breast, colon and prostate cancer and osteoporosis risk factors should be assessed in transgender women. Transgender men, on the other hand, should be screened for virilization signs, serum testosterone levels, drug side effects, annual PAP-smear if uterus is intact and mammography if breast tissue is intact, and osteoporosis risk factors. Surgery can only be proposed to individuals over 18 years of age who have completed 1 year of real-life experience with the usage of hormone therapy for at least 3 months during this period. However, it should be punctuated that surgical procedures constitute irreversible changes and they are not obligatory. Over long-term follow-up, transgender individuals who have undergone surgical procedures are reported to have increased suicide rates and psychiatric morbidities

Meningeal Irritation Signs in Patients With Acromegaly

Pituitary apoplexy may cause meningeal irritation signs because of blood and necrotic cells passed to subarachnoid space. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and reviewed as presenting signs in a few cases of acromegaly. We reported 2 acromegalic patients presented with signs of meningeal irritation. First case was a pituitary apoplexy of an undiagnosed growth hormone-secreting adenoma presented with the symptoms of acute meningitis. Second case was acromegaly complicated with acute viral meningitis. In both the patients, adjunctive glucocorticoid therapy provided good Outcomes., a( Physicians should be careful about differential diagnosis of patients with meningeal irritation signs. Rapid and early diagnosis of pituitary apoplexy may depend upon recognition of this rare presentation

Overt and Mild Subclinical Hypothyroidism Do Not Influence Mean Platelet Volume in Premenopausal Women Having Low Cardiac Risk

Mean platelet volume (MPV) was studied in subclinical hypothyroidism (SH) and the results are conflicting. The aim of this study is to assess how MPV is affected in overt hypothyroidism (OH) and mild SH, the 2 end points of hypothyroidism, in patients having low cardiac risk. Premenopausal women without any cardiac risk, 18 with OH, 30 with mild SH, and 37 euthyroid controls were enrolled. Overt hypothyroidism group had higher low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels than the control group (P < .001 and P < .05, respectively). Increase in MPV was insignificant in OH group when compared with SH and control groups. No correlation was observed between MPV and metabolic and hormonal parameters. Both OH and SH did not influence MPV and high-sensitivity C-reactive protein (hs-CRP) in patients with low cardiovascular risk, but these findings need to be further evaluated in this patient group

RET/PTC oncogene expression in papillary thyroid carcinoma and its correlation with clinicopathologic findings

Papillary thyroid carcinomas (PTCs) are the most frequent type of malignant thyroid tumors. Somatic rearrangements of the ret protooncogene are frequent genetic events in PTCs. Studies that are designed to determine the correlation between ret/PTC expression and biological characteristics, pathologic features, clinical behavior of PTC gave different results. We investigated the expression of ret/PTC oncogene product by immunohistochemistry to determine the relationship of ret/PTC expression with initial histopathologic findings, clinical markers, and prognosis in 44 papillary thyroid cancer patients. A monoclonal antibody was used. Patients between years 1995 and 2003 with a mean follow-up of 59 +/- 25 months (range 24-120) were evaluated retrospectively. Study group consisted of 38 women and 6 men, with a mean age of 44.6 +/- 11.2 years. Positive immunostaining was recorded if more than 5% of the tumor cells had intracytoplasmic staining. Adjacent nontumoral thyroid tissue was used as control. Seventeen (39%) of 44 patients showed intracytoplasmic staining specific for ret/PTC. Lymph node metastasis, capsule invasion, vascular invasion, soft tissue invasion, and multicentricity rates at initial examination were not significantly different between ret/PTC positive and negative patients. Turner size, follow-up period, age, and gender were not significantly different between ret/PTC positive and negative patients, either. These findings suggest that ret/PTC expression has no prognostic value in papillary thyroid cancer

The Metabolic Effects of Pre-probiotic Supplementation After Roux-en-Y Gastric Bypass (RYGB) Surgery: a Prospective, Randomized Controlled Study

Purpose Following Roux-en-Y gastric bypass (RYGB), positive alterations are observed in gut microbiota and intestinal peptides. Previous studies demonstrated similar alterations observed in cases when pre-probiotics are used without surgery. The aim of this trial was to evaluate the effectiveness of early use of pre-probiotics after RYGB

OUTCOMES OF ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY IN CUSHING'S DISEASE

Objective: Investigation of differences in the remission and recurrence rates of microadenoma and macroadenoma patients with Cushing's disease following transsphenoidal surgery (TS)